[COMPASS study results as a foundation for new treatment approach for neurological patients. Opinion of the expert council of december 18, 2021]. / Znachenie rezul'tatov issledovaniya COMPASS v izmenenii podkhodov k lecheniyu patsientov nevrologicheskogo profilya. Zaklyuchenie soveta ekspertov ot 18 dekabrya 2021 g.

The resolution of the Council of Experts devoted to the discussion of the effectiveness of the use of a combination of rivaroxaban 2.5 mg 2 times a day and acetylsalicylic acid 100 mg per day to prevent recurrent non-coronary ischemic stroke results of the COMPASS study is presented. The advantages of this combination and the safety of its use are considered. Recommendations for the implementation of the results of the study in clinical practice are given.

[The new Epoch of Antithrombotic Therapy in the Long-Term Prevention of a non-Cardioembolic Stroke].

This article presents current opinions on the role of antithrombotic therapy in secondary prevention of cardiovascular diseases (CVD) in patients after noncardioembolic stroke or a transient ischemic attack on the background of sinus rhythm. This review analytically analyses evidence-based data on antithrombotic drugs used for this secondary prevention. Despite the fact that acetylsalicylic acid (ASA) is still a "gold standard" for prevention of noncardioembolic stroke, the search for rational combinations of antithrombotic drugs to increase the effectiveness of preventive treatment is relevant. The question whether the rivaroxaban treatment as monotherapy or in combination with ASA is more effective than the ASA monotherapy for secondary prevention of cardiovascular complications (CVC) was addressed in the COMPASS study. In that study, three regimens of antithrombotic therapy were compared in patients with stable atherosclerotic CVD: rivaroxaban (2.5 mg twice a day) in combination with ASA (100 mg/day); rivaroxaban (5 mg twice a day); and ASA (100 mg/day). Risk for development of major CVC (death, stroke, myocardial infarction (IM)) was lower (p<0.001) in the rivaroxaban+ASA combination treatment group than in the ASA monotherapy group; however, the risk of major bleedings was somewhat higher. Total risk based on the definition of "pure clinical benefit" was lower for the rivaroxaban+ASA combination treatment than for the ASA monotherapy. The rivaroxaban monotherapy did not result in a significant decrease in the risk of major CVC compared to the ASA monotherapy but significantly increased the risk of major bleedings. Incidence of repeated ischemic stroke for a year was 1.1% for the combination therapy, 2.6% for the rivaroxaban therapy, and 3.4% for the ASA monotherapy with significant differences between the combination treatment group and the ASA monotherapy group (p<0.01). Relative risk of repeated stroke was 67% lower for the combination therapy group compared to the ASA monotherapy group. The combination of rivaroxaban (2.5 mg twice a day) and ASA (100 mg) opens a new epoch of antithrombotic treatment for primary and secondary prevention of stroke in patients with a stable atherosclerotic CVD and sinus rhythm.

[Prevention of ischemic stroke in atrial fibrillation from the point of view of a neurologist. Standards and real clinical practice].

The article outlines aspects of the current state of the problem of the priority choice of an oral anticoagulant for indefinite prevention of stroke and systemic thromboembolism in patients with atrial fibrillation. The advantages of direct oral angicoagulants over warfarin are presented, as well as a comparative analysis of the individual characteristics of the main direct oral angicoagulants from the point of view of personification of preventive therapy in accordance with modern treatment standards. The efficacy and safety of oral anticoagulant therapy has been reviewed in terms of the net clinical benefit. Particular attention is paid to the age-related aspects of choosing an anticoagulant for indefinite prophylaxis; an assessment of anticoagulants is presented in accordance with the FORTA concept, which regulates the use of drugs in elderly patients. In conclusion, recommendations are formulated for the choice of an anticoagulant in patients with atrial fibrillation in the most common clinical situations. As a general rule, the choice of a particular drug should be individualized based on risk factors, tolerability, net clinical benefit, patient preference, potential adverse interactions, and other clinical characteristics.

[Rivaroxaban at Non-Valvular Atrial Fibrillation: a Prospective Study and Clinical Practice].

The article presents an analytical review of the results of post-registration clinical studies on the efficacy and safety of rivaroxaban in nonvalvular atrial fibrillation (AF) to prevent stroke and other systemic thromboembolic complications. The main purpose of the first large prospective international observational study of rivaroxaban for stroke prevention in patients with non-valvular AF patients XANTUS was the analysis of efficacy and safety of rivaroxaban in clinical practice. Results of one year of observation of 6784 patients confirmed that rivaroxaban is effective and safe in real unselected population of patients with non-valvular AF and various stroke risk. The first Russian multicenter observational study Neuro-Xar dedicated to secondary prevention of stroke and systemic embolism, demonstrated the efficacy and safety of rivaroxaban in routine clinical practice. Lower risk of fatal intracranial and gastrointestinal bleeding was found in retrospective post-marketing studies, of rivaroxaban in the US, such as the PMSS and REVISIT-US. Rivaroxaban therapy was associated with reduced risk of the combined endpoint (ischemic stroke and intracranial hemorrhage).

[Arterial Hypertension and Optimization of Medication Prevention of Ischemic Stroke].

The article is devoted to the actual problem - the prevention of stroke in patients with arterial hypertension (AH). Mechanisms of cerebral complications of AH, the key areas of prevention of stroke are presented. On the basis of earlier large randomized trials justified the use of fixed combination products (polypills) comprising, along with antihypertensive lipid-lowering drugs, which is the key to improving treatment adherence and effectiveness of pharmacological prevention of stroke.

[Sleep-disordered breathing syndrome in acute ischemic stroke]. / Sindrom narusheniya dykhaniya vo sne pri ishemicheskom insul'te.

AIM: To evaluate the prevalence, structure and risk factors of sleep-disordered breathing in patients with acute ischemic stroke. MATERIAL AND METHODS: This prospective study included 54 acute ischemic stroke patients aged 66 [57; 72] years, 32 men, 22 women. The diagnosis was confirmed by MRI. The neurological state was assessed with the NIHSS and modified Rankin Scale (mRS). To verify the SDB, cardiorespiratory monitoring was performed on 2-5 day from stroke onset. Total number of SDB episodes, apnea/hypopnea index (AHI), the index of hypoxemia (IH) were registered. RESULTS AND CONCLUSION: SDB was detected in 50 (92%) patients, including 44 (88%) with predominantly obstructive apneas (OA), 6 (12%) patients with central apnea (CA). It was found that the severity of respiratory disorders did not depend on the severity of the neurological state but is associated with a variety of somatic, hemodynamic and metabolic disorders (increased BMI, smoking, diabetes mellitus,atrial fibrillation - AF). Cardioembolic stroke (СES) was accompanied by a more pronounced SDB and can be considered as a marker of respiratory disorders during sleep, especially in patients with AF. Involvement of the insula in the brain infarct zone is a significant factor in the development of SDB and increase of central apnea (CA). Multiple small deep (lacunar) infarcts of the brain, including asymptomatic infarcts, visualized by MRI also indicate a high risk of obstructive SDB.

[Prognostic factors of recurrent acute cerebrovascular incidents in patients with ischemic stroke]. / Prognosticheskie faktory razvitiya povtornykh ostrykh narushenii mozgovogo krovoobrashcheniya u bol'nykh s ishemicheskim insul'tom.

OBJECTIVE: To establish prognostic factors of recurrent acute cerebrovascular complications after ischemic stroke. MATERIAL AND METHODS: A prospective observational study on the 21-22nd day of the acute stage of ischemic stroke included 148 patients, aged 60 [5; 68] years. Following the discharge, a unified telephone survey of patients or their relatives was performed every 3 months. Recurrent strokes, including those with fatal outcome, and transient ischemic attacks (TIA) were recorded. RESULTS AND CONCLUSION: The long-term prospective follow-up duration was 35 [28; 40] months. In 26 (18%) patients, 31 cerebral complications, including 24 recurrent ischemic strokes, 6 TIA, 1 hypertensive intracerebral hemorrhage were registered. Recurrent cerebral complications found to be associated with age older 67 years, ischemic heart disease, multiple focal brain lesions, supraventricular arrhythmias more 46/day, bradyarrhythmias, ventricular arrhythmias. The use of thiazide and thiazide-liked diuretics as part of antihypertensive therapy was associated with a reduced risk of cerebral complications.

[Proignostic Factors of Cardiovascular Complications After Ischemic Stroke].

We included into prospective cohort observational study 148 patients with ischemic stroke aged 60 [52; 68] years. Duration of a prospective follow-up was 35 [28; 40] months. Cardiovascular events (CVE) registered during follow-up were recurrent stroke, transient ischemic attack, myocardial infarction, unstable angina, congestive heart failure, including acute decompensation of chronic heart failure requiring hospitalization, cardiovascular death. During follow-up 37 patients (25%) had 50 CVE. On multivariate regression analysis, independent predictors of CVE after ischemic stroke were: age over 67 years, presence of chronic ischemic heart disease, high grade ventricular arrhythmias, standard deviation of cardiointervals (SDNN) less than 71 ms, absence of thiazide diuretics in the basic antihypertensive therapy.

[Prognostic Factors of Cardiovascular Complications After Ischemic Stroke].

We included into prospective cohort observational study 148 patients with ischemic stroke aged 60 [52; 68] years. Duration of a prospective follow-up was 35 [28; 40] months. Cardiovascular events (CVE) registered during follow-up were recurrent stroke, transient ischemic attack, myocardial infarction, unstable angina, congestive heart failure, including acute decompensation of chronic heart failure requiring hospitalization, cardiovascular death. During follow-up 37 patients (25%) had 50 CVE. On multivariate regression analysis, independent predictors of CVE after ischemic stroke were: age over 67 years, presence of chronic ischemic heart disease, high grade ventricular arrhythmias, standard deviation of cardiointervals (SDNN) less than 71 ms, absence of thiazide diuretics in the basic antihypertensive therapy.